Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN1857093 | MA |
N | 1223G0001X | General Practice | 62522 | CA |
N | 213EG0000X | General Practice | 62522 | CA |
NPI | 1003256314 |
---|---|
Provider Name | Dr. Sang Hoon John Han |
First Address | East Wareham, MA 02538-4810 |
Second Address | East Wareham, MA 02538-4810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 09/11/2015 |